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NURSESSelecting the right communication system

BY MARK MEYERS, R.N., NE-BC

Long gone are the days of sim-ple push-button nurse callcables that provide basic com-munication from the patientbed to the nurses’ station.

Today’s nurse call systems are far morecomplex and offer significantly morecapabilities than their predecessors. As aresult, they also require substantiallymore attention in their planning, designand implementation.In simple terms, nurse call systems

enable patients and clinical staff to sum-mon help with visual and audible signals

for routine or emergency needs. Thesesystems also can summon emergencyresuscitation teams. Integrating the nursecall system with a staff locator systemcan identify the location of staff memberswithin the hospital through a central con-sole or special handsets.The effectiveness of a nurse call system

implementation, including how patientcalls are answered, can affect patient safe-ty and satisfaction, and nurse satisfaction. Alarm desensitization is a real problem

for today’s nurses as different devices(e.g., physiologic monitors, ventilators,

infusion pumps and bed-exit alarms)actively compete for their attention. Tocombat this desensitization, health carefacilities should conduct focused, multi-disciplinary discussion and planning sessions before, during and after systeminstallation to address the particular area-specific alarm demands that are placedon staff members. These planning sessions also should

ensure that alarm management is a primeconsideration when making functionalityand purchasing decisions for a nurse call system.

The EZ Care VitalTouchNurse Call Systemfrom SimplexGrinnell,Westminster, Mass.

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System requirementsNurse call systems are required by vari-ous codes and are mandated for facilitiesseeking accreditation by the Joint Com-mission. As such, these systems routinelyare included in the planning and designstage of new hospitals. The Occupational Safety and Health

Administration requires that all nurse callsystems be certified or approved by anationally recognized testing laboratorysuch as UL. Moreover, some states havespecified their own requirements fornurse call systems. Hospitals shouldcheck with their state department ofhealth for any regulations that may applyto their area.Existing systems

vary in their degree ofexpandability. Thosehaving only visual oraudible signal displayscan, under some cir-cumstances, be modi-fied for voice communi-cation, provided theconduits are largeenough for additionalwiring. When planning for

new systems, Category 5computer networkingcable seems to be thewiring of choice withmost vendors in hospitalenvironments. Many sup-pliers can custom designsystems to interface withother communicationssystems (e.g., staff reg-istries or pagers).In addition, some systems

interface with admission, dis-charge and transfer (ADT) sys-tems that are Health Level 7(HL7) compliant. HL7 is an electronic datainterchange standard.

Four major elementsMost nurse call systems consist of the fol-lowing four major elements:

Central console. In addition to priori-tizing calls, central consoles usually dis-play the room number and status of thecall. The central console also may trackand display the length of time that a callhas been in the system — from the timethe call is initiated until a room responseis indicated. A call reminder feature (ifavailable), usually programmed by thehospital, alerts the attendant if a patient

has not received attention within a pre -determined time frame. The annunciator,or signaling apparatus, usually is locatedat the nursing station with the centralconsole and is often out of seeing andhearing range of patient rooms.

Room stations. A room station is adevice that can create a signal that can beinitiated by patients or staff at patients’bedsides, in bathrooms and showers, aswell as in utility rooms and other areas.Call devices come in various designs andmany are wall-mounted with push but-tons and lights on the faceplate. Pendant-style switches have a push-button switchat the end of a cable, or cordset, that

plugs into ajack in thewall-mount-ed bedside

station. Some hospital beds have cordsetsmounted on the side rails and provideadapters for interfacing with the nursecall system.Typical patient rooms will have the fol-

lowing room stations:• A simple device for patients to call for

assistance from their bed (either a cordsetor integrated into the bedside rail).• A push-button, wall-mounted plate at

each bedside to allow caregivers to callother staff or announce emergency situa-tions (e.g., staff assist or Code Blue).• Pull-cord stations in a patient lavatory

to alert staff to a request for assistance oremergency situation.

Hallway communication stations.These are strategically placed stationsthat allow caregivers, who may be inremote or isolated locations on their unit,to be notified of calls. They can bedesigned to show which patient is callingor only have the ability to communicatewith the front desk, with no display toensure patient confidentiality.

Corridor or intermediate stationlights. These types of lights are locatedoutside patient rooms and corridor inter-sections and are illuminated when callsare signaled, to assist the staff in locatingthe calling room. The call signal isrelayed to the central console, which trig-gers an audible tone and a display of thecalling room number. Signals from bath-rooms and showers trigger tone and lightsignals (usually pulsating) that are differ-

ent from the calls frombeds, because lavatorycalls may require moreimmediate attention.

Enhanced system optionsBeyond traditionalnurse call systems are enhanced, ormicroprocessor-based,systems. Their centralconsoles can be pre -programmed to hospitalspecifications or they canbe user programmed,which permits staff to enterthe name, room numberand medical data ofeach patient. The following attri -

butes should be consideredwhen looking at an enhanced

nurse call system:Interfacing to the hospital information

system (HIS) and ADT system. Today’senhanced systems can interface with theHIS and ADT system to allow access topatient-identification information. With these enhanced nurse call sys-

tems, caregivers can be assigned respon-sibility for specific patients or roomsthrough the master console. Thus, when apatient places a call, the system caneither display the names of the assignedcaregivers on the console or direct thecall to the appropriate caregiver. This helps to identify the appropriate

person to respond to the call, and somesystems also will display and forward thepatient call directly to a radio pager or

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LEFT PHOTO COURTESY OF SIMPLEXGRINNELL; RIGHT PHOTO COURTESY OF RAULAND-BORG CORP.

Several of the componentsthat make up Mount Prospect,Ill.-based Rauland-Borg Corp.’s Responder 5 nurse call system.

wireless phone number, if available. Afew systems even display a graphical representation of the floor layout thatshows, for example, the patient’s nameand status along with the names of anycaregivers in the room.

Integrated staff/equipment locatoroptions. The nurse call system also mayhave an integrated staff locator system —an infrared (IR) or radio-frequency (RF)transmitter badge, wristband or similardevice that wirelessly communicates withan installed locator detector. Detectors, which often are incorporat-

ed into the room stations, can transmitstaff or equipment-identification informa-tion to the nurse call system. These detec-tors also may be located in the ceiling orelsewhere in the structure of the hospital.With an IR or RF locator-system inter-

face, the master station may provide aconstant display of staff location. Withappropriate software, the display may bealtered to show the location of staff byjob description (e.g., registered nurse orhousekeeping). The system also may havenurse-follower capabilities whereby thesystem constantly senses a staff mem-ber’s location and routes all patient bed-side calls to the appropriate location. The locator system also can be used to

cancel patient calls automatically when astaff member of the appropriate level, orone assigned to the patient, enters thepatient’s room.

Management and quality-controlcapabilities. Almost any basic nurse callreporting system can report on callsplaced and on time elapsed until a call iscanceled. However, a reporting system’scapabilities can be expanded dramatical-ly when the system is used in conjunc-tion with an automatic-locator system.

For example, the facility can track whichcaregiver answered a call and how longthe caregiver was in the room. It cantrack response times to ensure adequatestaffing. It also can collect data on whereindividual caregivers spend their time. The ability to capture and analyze this

type of information can prove valuablewhen planning staffing levels or whenevaluating different patient care models.For example, the facility can use the datato monitor the effects of different staffinglevels or care models on response times.With some systems, data can be present-ed graphically (e.g., through the use ofbar and pie charts).

Interconnectivity with other devicesfor alarm notification. Hospitals can inter-face nurse call systems with other equip-ment such as bed-exit detectors, physiolog-

ic patient monitors, ventilators and infu-sion pumps to enhance alarm notificationfrom these devices. However, the nurse callsystem must be preconfigured to connectthese devices and there may be limitationsin distinguishing each device’s alarm.Many organizations use their nurse call

systems to enhance their alarm notifica-tion. This may be considered an off-labelapplication for either the nurse call sys-tem or device or both. Often a custom cable connection may

need to be created that is not approvedfor use by the nurse call system or thespecific device. If an organization has cre-ated or manufactured a cable to connectthe device to the nurse call system, theorganization then has taken on theresponsibility for all alarms being reliablytransmitted to the nurse call system.

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PHOTOS COURTESY OF TEKTONE®, WWW.TEKTONE.COM

Components of thenurse call system madeby Jeron Electronic

Systems Inc., Chicago.

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This pillow speaker fromTekTone, Franklin, N.C., cancall the nurse master sta-tion as well as control theroom’s TV, radio and lights.

TekTone’s nursemaster stationincludes a touchscreen and a full,slide-out keyboard.

PHOTO COURTESY OF JERON ELECTRONIC SYSTEMS INC.

Therefore, the organization also hasassumed the liability for correct alarmtransmission to the nurse call system andcorresponding alarm notification by thenurse call system. The federal government has its eye on

the exchange of medical device data andit is expected that it soon will offer regu-lations for, and require oversight of, thistype of information transfer. The regula-tions likely will affect not only devicemanufacturers, but health care facilitiesthat have developed, or will develop,home-grown systems that satisfy the defi-nition of a medical device data system(MDDS). Therefore, it is likely that thehealth care facility that has developed anin-house system will be subject to theproposed MDDS ruling as if it were amedical device manufacturer.

Purchasing considerationsMany organizations are considering in -terfacing bedside equipment with theirnurse call systems to enhance alarmmanagement. But without proper com-munication and planning among care-givers prior to the integration, what start-ed out as alarm-management safetyenhancements could devolve into alarmdesensitization and fatigue. Selecting the proper team (e.g., nursing

staff, information technology and bio-medical engineering personnel) and hav-ing them review the features of a newnurse call system are essential to its suc-cess. Without buy-in or acceptance fromnurses or other staff members who mayresist change, the system will fail no mat-ter how well-conceived or implemented. To overcome this, staff members

should be involved early in the evaluationand selection process. The equipmentpurchasing team should consider thestaff’s needs and concerns when makingdecisions. If nothing else, the medicalstaff will know that their input wassought and valued. It is more likely, how-ever, that nurses and others who are mostaware of day-to-day patient care opera-tions will be in the best position to guidedecision-making.As with other new programs (such as

patient-safety initiatives), selection of oneor more champions on the staff can beextremely beneficial to system imple-mentation and staff buy-in. These repre-sentatives will be in the best position toexplain to their colleagues how proposedsystems can affect their jobs and lead topotential patient care improvements.

Once systems are chosen, staff must befully trained as part of the system’simplementation. Suppliers typically willprovide some training for facility staffwho then are responsible for training other users. The amount and timing ofsupplier-provided training usually isnegotiable and purchase committeesshould discuss options with each supplier. Initial training should allow sufficient

time for staff to become comfortable withthe system and have their questionsanswered. Supplemental training may benecessary as users become familiar withthe systems and develop new questionsabout various features. Facility managersalso can identify areas where follow-uptraining is necessary by monitoring staffresponse times and other data andreports generated by the systems.

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PHOTO COURTESY OF VOCERA COMMUNICATIONS INC.

Interfacing nurse call systems with handheld communications

For the most part, the primary handheld communication devices used bynurses in the health care environment are pagers and wireless telephonesystems.

When a nurse call system is interfaced with a radio-pager system, pages can beinitiated either by the attendant using the master console (attended mode) or bythe patient activating the call button (unattended mode). A combination approachalso can be used. Typically, these systems are configured so that pages for a spe-cific patient or bed are directed either to an individual caregiver’s pager or to allthe pagers in a pager group — which may consist of, for instance, the personnelon the patient care team (i.e., a nurse) assigned to that patient. Although pagers with simple numeric displays may be used, enhanced nurse call

systems typically are used with pagers that have large alphanumeric displays con-taining at least 32 characters. These pagers allow details about the call to be com-municated along with the page. Through use of prede-fined alphanumeric messages, caregivers can deter-mine the urgency of a call and the appropriate actionto take before going to the patient’s location.When utilizing a pager system, ensure that the sys-

tem capacity is sufficient to handle the volume ofnurse call notifications. Overloading the paging sys-tems may cause delayed or missed pages.When incorporated into nurse call systems, wire-

less phones provide the same alphanumeric displaycapability of a pager system, but also allow the care-giver to use the phone to speak directly through thenurse call intercom with the patient or the attendantat the master console, including being connected asextensions of the facility telephone system’s privatebranch exchange (PBX). Full-function integration will, at times, allow caregivers to fulfill a patient’s request

without leaving their current locations. Caregivers also can use wireless phones tokeep in touch with physicians, other caregivers or a patient’s family members.There are three common methods of providing wireless telephone service. One

is using wireless phones to connect to the hospital’s PBX. This is similar to a wire-less phone used in many homes. Voice over Internet Protocol is another method ofwireless phone communication that utilizes a hospital’s wireless infrastructure.The last method is to use a distributed antenna system. This equips a facility withan internal wireless network similar to a cellular phone network. Careful planning is required before a wireless telephone system is deployed to

ensure that the system will not adversely affect other wireless devices and sys-tems, that it will provide adequate coverage and that it will be of sufficient qualityand reliability. Facilities that use the technology must address these issues toensure the confidentiality and reliability of voice communications. �

A mobile communications system from Vocera Communi-cations Inc., San Jose, Calif.

Health facilities considering the pur-chase of an enhanced nurse call systemalso should take the following steps:• Contact the state department of

health for more information on localnurse call system requirements.• Address interconnectivity, alarm noti-

fication processes and wireless communi-cation devices (e.g., phones and pagers)as part of the planning process.• Consider standardization of audible

and visual cues for different levels ofalarms and protocols for notification andresponse to the calls from the system.• Incorporate data recorded by systems

in conjunction with patient and familyfeedback as part of the facility’s overallquality-improvement activities.

A patient lifelineIt’s no exaggeration to say that a fullyfunctioning nurse call system is a lifelinebetween the patient and the hospital’sclinical staff. With careful planning andselection, health facility professionals canhelp strengthen that lifeline. HFM

Mark Meyers, R.N., NE-BC, is senior

associate in the Applied Solution

Group at ECRI Institute, Plymouth

Meeting, Pa. He can be reached at

mmeyers@ecri.org.

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Remote monitoring adds twist to patient communication

While not directly related to the communication infra-structure of nurse call systems, remote patientmonitoring is growing in interest as another way for

caregivers and their patients to stay in touch, especially in situ-ations where patients can be monitored from home.

For conditions thathave traditionallyhigh readmissionrates, such as dia-betes and conges-tive heart failure, thetechnology forremote patient moni-toring is becomingcritical to managingpatients’ care and

keeping them out of the hospital. Home-based health monitor-ing technologies have evolved greatly since their inception inthe 1970s when medical-alert systems enabled patients toalert a call center after falling or while experiencing chestpains. Today’s sophisticated systems include monitors, clinical

information databases, Internet-based decision support tools,health-management programs and content-development tools. Nonetheless, remote management of patients by telephone

or e-mail historically has a poor reimbursement track record inthe United States. Reimbursement may improve, however,because the American Medical Association established eightnew Category I Current Procedural Terminology (CPT) codes tofacilitate reimbursement effective January 2008. These includeCPT codes for telephone assessment and management andonline evaluation and management of an established patient.Interoperability is also a key part of patient monitoring, both

on-site and remotely. However, the lack of progress in creatingelectronic health records stymies integration of clinical data foraccess by care providers. Expanded home-monitoring capabilities using the Internet for

such data as blood glucose levels and blood pressure read-ings, have been developed by some manufacturers in an effortto cut treatment costs while improving a patient’s quality oflife. Candidates for home monitoring are patients who are wellenough to be discharged but whose chronic conditions necessi-tate close follow-up to prevent frequent hospitalization. �

Andover, Mass.-based Philips

Healthcare’s Tele-health product line.

PHOTO COURTESY OF PHILIPS HEALTHCARE